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This article is part of the supplement: Learning from large scale prevention efforts: findings from Avahan

Open Access Research

The costs of HIV prevention for different target populations in Mumbai, Thane and Bangalore

Sudha Chandrashekar12*, Anna Vassall1, Bhaskar Reddy3, Govindraj Shetty3, Peter Vickerman1 and Michel Alary4

Author Affiliations

1 London School of Hygiene and Tropical Medicine, London, UK

2 St Johns Research Institute, India

3 Karnataka Health Promotion Trust, Bangalore, India

4 Centre hospitalier affilié universitaire de Québec, Canada

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BMC Public Health 2011, 11(Suppl 6):S7  doi:10.1186/1471-2458-11-S6-S7

Published: 29 December 2011

Abstract

Background

Avahan, the India AIDS Initiative, delivers HIV prevention services to high-risk populations at scale. Although the broad costs of such HIV interventions are known, to-date there has been little data available on the comparative costs of reaching different target groups, including female sex workers (FSWs), replace with ‘high risk men who have sex with men (HR-MSM) and trans-genders.

Methods

Costs are estimated for the first three years of Avahan scale up differentiated by typology of female sex workers (brothel, street, home, lodge based, bar based), HR-MSM and transgenders in urban districts in India: Mumbai and Thane in Maharashtra and Bangalore in Karnataka. Financial and economic costs were collected prospectively from a provider perspective. Outputs were measured using data collected by the Avahan programme. Costs are presented in US$2008.

Results

Costs were found to vary substantially by target group. Non-governmental organisations (NGOs) working with transgender populations had a higher mean cost (US $116) per person reached compared to those dealing primarily with FSWs (US $75-96) and MSWs (US $90) by the end of year three of the programme in Mumbai. The mean cost of delivering the intervention to HR-MSMs (US $42) was higher than delivering it to FSWs (US $37) in Bangalore. The package of services delivered to each target group was similar, and our results suggest that cost variation is related to the target population size, the intensity of the programme (in terms of number of contacts made per year) and a number of specific issues related to each target group.

Conclusions

Based on our data policy makers and program managers need to consider the ease of accessing high risk population when planning and budgeting for HIV prevention services for these populations and avoid funding programmes on the basis of target population size alone.